Yi NJ, Suh KS, Cho JY, Kwon CH, Lee KU
外科，首尔大学医学院，首尔，韩国
总肝管空肠Roux-en-Y吻合术（RYHJ）已经成为成人-成人活体肝移植（ALDLT）中标准的胆管重建术。目前又引入了端端吻合术（DD）。
本研究比较了RYHJ和DD的疗效。四年间共有74例受体进行了ALDLT，并且接受了至少2年的随访。我们将患者分为3组，第1组为RYHJ组，18名患者；第2组为带支架的DD组（DD+ S），35人；第3组为不带支架的DD组（DD - S），21人。
总之，32.4%的患者发生了胆道并发症。RYHJ组、DD + S组和DD – S组胆道并发症的发病率分别为11.1%、48.5%和33.3%（P=0.047）。DD + S组中28.5%的患者发生了胆漏。RYHJ组、DD + S组和DD – S组胆道狭窄的发病率分别为5.3%、20.2%和28.6%。大部分并发症（83.3%）不经过手术也能治愈。在ALDLT中，RYHJ的长期疗效要好于DD。DD组的亚组分析显示DD – S组没有出现胆漏，但胆管狭窄的发病率依然较高。
然而，由于这是一个回顾性研究，因此可供分析的数据和得出的结论都是有限的。至此，还需要进行一个前瞻性随机研究来证明以上发现。
In adult-to-adult living donor liver transplantation hepaticojejunostomy shows a better long-term outcome than duct-to-duct anastomosis
Yi NJ, Suh KS, Cho JY, Kwon CH, Lee KU
Department of Surgery, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea.
Roux-en-Y hepaticojejunostomy (RYHJ) has been the standard biliary reconstruction in adult-to-adult living donor liver transplantation (ALDLT). Recently, duct-to-duct anastomosis (DD) has been introduced.
This study compared the outcomes of RYHJ and DD. For 4 years, 74 recipients underwent ALDLT and were followed up for at least 2 years. The patients were divided into three groups, RYHJ group (n = 18), DD with a stent (DD + S) group (n = 35), and DD without a stent (DD - S) group (n = 21).
Overall, biliary complications were developed in 32.4% patients. The biliary complication rate was 11.1%, 48.5% and 33.3% in RYHJ, DD + S and DD - S groups, respectively (P = 0.047). Bile leaks occurred in 28.5% of DD + S group. The incidence of biliary stricture was 5.3%, 20.2% and 28.6% in RYHJ, DD + S and DD - S group, respectively. Most complications (83.3%) were resolved nonsurgically. RYHJ has a better long-term outcome than DD in ALDLT. Subgroup analysis of DD group showed that DD - S group had no bile leaks, but still had a higher incidence of bile duct strictures.
However, because this study was a retrospective review there are limitations in analyzing the data and confirming the conclusion. A randomized-prospective study will be needed to confirm these findings.
PMID: 16221154 [PubMed - indexed for MEDLINE
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